EP3863534B1 - Rückholwerkzeug für medizinische vorrichtungen mit einstellbarer krümmung - Google Patents

Rückholwerkzeug für medizinische vorrichtungen mit einstellbarer krümmung Download PDF

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Publication number
EP3863534B1
EP3863534B1 EP19795390.4A EP19795390A EP3863534B1 EP 3863534 B1 EP3863534 B1 EP 3863534B1 EP 19795390 A EP19795390 A EP 19795390A EP 3863534 B1 EP3863534 B1 EP 3863534B1
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EP
European Patent Office
Prior art keywords
imd
retrieval
curve
fixed
snare
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EP19795390.4A
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English (en)
French (fr)
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EP3863534A1 (de
Inventor
Ronald A. Drake
Kendra Lange
Kathryn Hilpisch
Michael D. Eggen
Matthew D. Bonner
Brian P. COLIN
Pierce J. VATTEROTT
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Medtronic Inc
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Medtronic Inc
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B17/221—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/50—Instruments, other than pincettes or toothpicks, for removing foreign bodies from the human body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/372—Arrangements in connection with the implantation of stimulators
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/372—Arrangements in connection with the implantation of stimulators
    • A61N1/375—Constructional arrangements, e.g. casings
    • A61N1/37512—Pacemakers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00238—Type of minimally invasive operation
    • A61B2017/00243—Type of minimally invasive operation cardiac
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/003—Steerable
    • A61B2017/00318—Steering mechanisms
    • A61B2017/00331—Steering mechanisms with preformed bends
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00358—Snares for grasping
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00831—Material properties
    • A61B2017/00853—Material properties low friction, hydrophobic and corrosion-resistant fluorocarbon resin coating (ptf, ptfe, polytetrafluoroethylene)
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B17/22031—Gripping instruments, e.g. forceps, for removing or smashing calculi
    • A61B2017/22035—Gripping instruments, e.g. forceps, for removing or smashing calculi for retrieving or repositioning foreign objects
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B17/221—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions
    • A61B2017/2212—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions having a closed distal end, e.g. a loop
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/372—Arrangements in connection with the implantation of stimulators
    • A61N1/37205—Microstimulators, e.g. implantable through a cannula
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/372—Arrangements in connection with the implantation of stimulators
    • A61N1/375—Constructional arrangements, e.g. casings
    • A61N1/3756—Casings with electrodes thereon, e.g. leadless stimulators
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/02—Details
    • A61N1/04—Electrodes
    • A61N1/05—Electrodes for implantation or insertion into the body, e.g. heart electrode
    • A61N1/056—Transvascular endocardial electrode systems
    • A61N1/057—Anchoring means; Means for fixing the head inside the heart
    • A61N2001/0578—Anchoring means; Means for fixing the head inside the heart having means for removal or extraction

Definitions

  • This disclosure relates to interventional medical systems for retrieving medical devices, such as from implant sites within a patient.
  • implantable cardiac pacemakers include a pulse generator device to which one or more flexible elongate lead wires are coupled.
  • the pulse generator device may be implanted in a subcutaneous pocket, remote from the heart, and each of the one or more lead wires extends therefrom to a corresponding electrode, coupled thereto and positioned at a pacing site, either endocardial or epicardial.
  • Mechanical and/or MRI compatibility issues may be associated with elongate lead wires.
  • Relatively compact implantable medical device IMD have been developed that are wholly contained within a relatively compact package, the entirety of which is configured for implant in close proximity to the pacing site, US 2017/0043158 A1 relates to interventional medical systems and catheters.
  • an IMD retrieval system may include an elongate outer tubular member defining longitudinally extending lumen terminating in a distal cup and a retrieval assembly position in the lumen of the elongate outer tubular member.
  • the retrieval assembly may include a retrieval member having a distal snare moveable between an expanded configuration to receive the IMD and a contracted to engage the IMD and a fixed-curve catheter
  • the fixed-curve catheter may define a lumen in which the retrieval assembly extends in sliding engagement, and the fixed-curve catheter may extend in sliding engagement within the lumen of the elongate outer tubular member.
  • the fixed-curve catheter may include a resilient material forming a distal curve relative to a longitudinal axis of the fixed-curve catheter.
  • the distal curve of the fixed-curve catheter may be controllable between a substantially straight configuration when the distal curve is retracted into or otherwise located within the distal cup of the elongate outer tubular member and an at least partially curved configuration when the distal curve is extended from the distal end of the distal cup.
  • the fixed-curve catheter provides a clinician with improved control of an orientation of the snare, distal cup, and other portions of the IMD retrieval system to reduce retrieval time.
  • an implantable medical device (IMD) retrieval system may include an elongate outer tubular member and a retrieval assembly.
  • the elongate outer tubular member may include a handle configured to control an orientation of the elongate outer tubular member, and a longitudinally extending lumen terminating in a distal cup.
  • the distal cup may be configured to receive the IMD.
  • the retrieval assembly may include a retrieval member and a fixed-curve catheter.
  • the retrieval member may include an elongate member terminating in at least one snare, where the at least one snare is moveable between an expanded configuration and a contracted configuration; and a torque member configured to control rotation of the retrieval member about a longitudinal axis of the elongate member.
  • the fixed-curve catheter may include a core layer comprising a resilient material and defining a lumen in which the retrieval assembly extends in sliding engagement.
  • the fixed-curve catheter may define a distal curve and may extend in sliding engagement within the lumen of the elongate outer tubular member.
  • a method of retrieving an implantable medical device may include introducing an implantable medical device (IMD) retrieval system into the vasculature of a patient
  • the IMD retrieval system may include an elongate outer tubular member including a longitudinally extending lumen terminating in a distal cup, where the distal cup is configured to receive the IMD, and a retrieval assembly including a retrieval member that includes an elongate member terminating in at least one snare, where the at least one snare is moveable between an expanded configuration and a contracted configuration, and a fixed-curve catheter that includes a resilient material forming a distal curve and defining a lumen in which the retrieval assembly extends in sliding engagement where the fixed-curve catheter extends in sliding engagement within the lumen of the elongate outer tubular member.
  • the method also may include controlling the retrieval assembly to receive the IMD in the snare.
  • the method also may include controlling the retrieval assembly to engage the IMD in the s
  • An example system includes an elongate outer tubular member and a retrieval assembly.
  • the elongate outer tubular member may include a longitudinally extending lumen terminating in a distal cup.
  • the distal cup may be configured to receive the IMD.
  • an inner diameter of the distal cup in proximity to a distal opening of the lumen may be sized to contain the IMD therein.
  • the retrieval assembly may include a retrieval member and a fixed-curve catheter.
  • the retrieval member may include an elongate member terminating in at least one snare.
  • the at least one snare may be moveable between an expanded configuration and a contracted configuration.
  • the expanded configuration may be configured to receive the IMD
  • the contracted configuration may be configured to engage the IMD to attach the retrieval member to the IMD via the snare for retrieval of the IMD.
  • the fixed-curve catheter may include a resilient material forming a distal curve. The distal curve is relative to a longitudinal axis of the fixed-curve catheter.
  • the fixed-curve catheter also may define a lumen in which the retrieval assembly extends in sliding engagement. Further, the fixed-curve catheter may extend in sliding engagement within the lumen of the outer tubular member.
  • the curved portion of the fixed-curved catheter may be selectively straightened or bent as desired to a retrieval process, e.g., by sliding the curved portion of the fixed curve catheter relative to the distal cup of the elongate outer tubular member.
  • the curved portion of the fixed-curved catheter may have exhibit a first curvature, e.g., the fixed-curve.
  • the rigid cup may apply a force to the curved portion based on the generally straight configuration of die rigid cup and rigid material.
  • the curvature of the curved portion of the fixed-curved catheter may decrease the further the curved portion is slid within the straight rigid cup.
  • the straight rigid cup may act on the curved portion such that the curved portion has a substantially straight orientation or at least a curvature that is less than the first curvature of the curved portion when it is entirely outside the straight rigid cup.
  • an IMD may be difficult to retrieve after implantation.
  • retrieval of an IMD implanted in a chamber of the heart of a patient may include navigating an IMD retrieval system including a catheter through vasculature to an implant site.
  • an IMD retrieval system may include a snare, such as a loop snare, extending through a lumen of the catheter.
  • a clinician may manipulate the orientation of the snare to receive the IMD (e.g., position a loop snare over the IMD), engage the IMD (e.g., tighten the loop snare to mechanically couple to the IMD), and/or retrieve the IMD (e.g., pull the IMD from the implant tissue).
  • manipulation of the snare may be limited to controlling longitudinal position or rotation of the snare relative to a longitudinal axis of the catheter. For example, once positioned near the implant site, the catheter may be difficult to orient in a three dimensional space.
  • the disclosure describes a system for retrieving an IMD that includes an elongate outer tubular member and a retrieval assembly.
  • the elongate outer tubular member may include a longitudinally extending lumen terminating in a distal cup that is configured to receive the IMD.
  • a distal portion of the elongate outer tubular member e.g., proximal the distal cup, may include a distal curve relative to the longitudinal axis of the elongate outer tubular member.
  • the retrieval assembly includes a retrieval member and a fixed-curve catheter.
  • the retrieval member includes an elongate member terminating in at least one snare.
  • the fixed-curve catheter includes a resilient material forming a distal curve. The distal curve is relative to a longitudinal axis of die fixed-curve catheter.
  • the fixed-curve catheter may extend in sliding engagement within the lumen of the outer tubular member. By including the distal curve in sliding engagement with the lumen of the outer tubular member, the fixed-curve catheter is controllable between a substantially straight configuration when retracted into the distal cup of the outer tubular member and an at least partially curved configuration when extended from the distal end of the distal cup.
  • the distal cup allows the fixed-curve catheter to take on an adjustable curve shape depending on the longitudinal position of the distal curve of the fixed-curve catheter relative to the distal opening of the distal cup.
  • a longitudinal axis of the retrieval member may be substantially the same as the longitudinal axis of the elongate outer tubular member.
  • the distal cup urges the fixed-curve catheter into a substantially straight configuration, e.g., straight or nearly straight relative to the longitudinal axis of the elongate outer tubular member.
  • a longitudinal axis of the retrieval member may bend at an angle relative to the longitudinal axis of the elongate outer tubular member.
  • the fixed-curve catheter is allowed to take on its shape as the distal curve extends out of the distal cup. If only a portion of the distal curve extends out of the distal cup, the curve may be slight. If more of the distal curve extends out of the distal cup, the curve may be more pronounced.
  • the adjustable curve of the fixed-curve catheter provides enhanced steering of the snare. For example, by enabling a clinician to control a degree of curvature of the fixed-curve catheter.
  • the fixed-curve catheter may enable secondary curves.
  • the secondary curves may be manipulated by a clinician, e.g., by controlling the degree of curvature of die fixed-curve catheter, the radial orientation of the distal curve of the fixed-curve catheter relative to the curve of the elongate outer tubular member, or both, to improve control of the snare in three dimensional space.
  • the retrieval system may reduce the time to properly receive the IMD for engagement, improve navigation of the snare in smaller spaces, and/or maintain tension transverse to a longitudinal axis of the IMD during engagement.
  • the clinician may control the degree and/or orientation of the distal curve fixed-curve catheter to apply a side load to the IMD housing, e.g., tipping the IMD slightly.
  • a side load to the IMD housing may be useful in forcing one side of the snare to ride along the IMD housing as the snare is controlled from an expanded configuration to a contracted configuration.
  • the side load helps the snare engage a groove in a proximal retrieval feature on the IMD.
  • the system may reduce the time to properly engage the IMD for retrieval.
  • the orientation of the IMD relative to the distal cup may make it difficult to seat the distal cup over the IMD prior to retrieval.
  • the distal opening of the distal cup may catch in the groove of the proximal retrieval feature.
  • the fixed-curve catheter may facilitate reorienting the distal cup by rotating the distal cup relative to the fixed-curve catheter, and thereby relative to the IMD. In other words, spinning the fixed-curve catheter allows the distal cup to change orientation relative to the IMD, guiding the distal cup to an orientation that allows the IMD to be retrieved into the distal cup.
  • the fixed-curve catheter may be slid up to the proximal retrieval feature.
  • the tip of the fixed-curve catheter may include a coil tip (or similar) that is sized to divert the distal cup away from the groove of the proximal retrieval feature.
  • the system may be used for lead extraction with the elongate outer tubular member providing countertraction.
  • Countertraction may be desirable during lead extraction to prevent the heart wall from inverting or pulling with the lead as the lead is pulled. For example, if the lead is encapsulated, it will not pull out (or rotate out) easily. Applying countertraction provides a counter force to focus the extraction energy to the lead implant site.
  • the fixed-curved catheter may be used as part of the snare cinching mechanism.
  • a snare including a metal loop element may be locked in place relative to an elongate member, e.g., a snare catheter, thereby engaging the IMD.
  • the snare catheter may be slid as a unit inside the fixed-curved catheter, e.g., such that a distal tip of the fixed-curve catheter contacts the engaged snare and IDM.
  • the snare catheter may be held relative to the fixed-curve catheter via a torque member to keep the snare tight on the proximal retrieval feature during removal.
  • sliding the snare catheter inside the fixed-curve catheter may block a groove of a proximal retrieval feature of an IMD to prevent the proximal retrieval feature from catching on the distal cup.
  • sliding the snare catheter inside the fixed-curve catheter may be used to orient the IMD to align with the distal cup.
  • sliding the snare catheter inside the fixed-curve catheter may enable the fixed-curve catheter to guide the distal cup over the IMD.
  • the fixed curve catheter can be used in place of retrieval member (e.g., snare and snare catheter) to minimize steps.
  • FIG. 1 is a conceptual and schematic diagram illustrating potential cardiac implant sites for a relatively compact IMD.
  • a relatively compact IMD may be implanted on or within heart 100 of a patient, such as within an appendage 102 of a right atrium (RA), within a coronary vein (CV) via a coronary sinus ostium (CSOS), or in proximity to an apex 103 of a right ventricle (RV).
  • the relatively compact IMD may be implanted on other portions of heart 1 00 or implanted in locations other than heart 100, such as any suitable implant site in a body of the patient.
  • FIG. 2 is a conceptual and schematic diagram illustrating an example relatively compact implantable medical device 300 (IMD 300) having been implanted by a clinician using a IMD implant system 200.
  • IMD implant system 200 may implant IMD 300 using the techniques and/or interventional medicine systems, tools, or assemblies as described in United States Patent No. 9,526,522 .
  • a clinician may advance IMD implant system 200 into the RV of heart 100 through the RA. and inferior vena cava (IVC) via a femoral access site.
  • the clinician may deploy IMD 300 from a device receptacle 230 of IMD implant system 200.
  • FIG. 3 is a plan view of implantable medical device 300.
  • FIG. 3 illustrates device 300 including a housing 380 extending from a proximal end 381 thereof to a distal end 382
  • housing 380 may be hermetically sealed.
  • an electronic controller (not shown), for example, a pulse generator and an associated power supply, may be contained in housing 380.
  • Device 300 includes an electrode 320 and a fixation member 350, both mounted in proximity to distal end 382 of housing 380.
  • Electrode 320 may be electrically coupled to the controller via a hermetically sealed feedthrough assembly (not shown).
  • Housing 380 may be formed from a biocompatible and biostable metal such as, for example, titanium, and overlaid with an insulative layer such as, for example, medical grade polyurethane, parylene, or silicone.
  • device 300 may include another electrode (not shown), for example, formed by removing a portion of the insulative layer to expose the metallic surface of housing 380. The other electrode may function in conjunction with electrode 320 for bipolar pacing and sensing, when fixation member 350 secures electrode 320 in intimate tissue contact at a target implant site.
  • FIG. 3 further illustrates device 300 including an optional proximal retrieval feature 310 joined to proximal end 381 of housing 380.
  • Proximal retrieval feature 310 may be configured for snaring, for example, by a retrieval member.
  • device fixation member 350 includes a plurality of fingers 35 spaced apart from one another around a perimeter of device housing distal end 382, wherein fingers 35 are configured to fix device 300 to tissue at an implant site. Although only two fingers 35 of fixation member 350 are illustrated in FIG 3 , fixation member 350 may include as many as eight fingers 35 or more than eight fingers 35. According to one example, fixation fingers 35 are integrally formed with one another, having been cut from nickel titanium alloy tubing or other biocompatible tubing. After cutting the nickel titanium alloy tubing, fingers 35 may be shaped by bending and holding fingers 35 in the illustrated curvature while undergoing heat treatment.
  • Fixation member 350 may be mounted to distal end 382 of device housing 380, for example, in a manner similar to that described for a fixation component 102 in United States Patent Application Publication No. 2012/0172690 .
  • the super-elastic nature of nickel titanium alloy allows fingers 35 to elastically deform between a relaxed condition and an extended condition, in which a free end 305 of each finger extends distally away from distal end 382 of device housing 380.
  • FIG. 4A--4E are conceptual and schematic diagrams illustrating an example implantable medical device retrieval system.
  • FIG. 4A illustrates retrieval system 200 having been advanced to the implant site.
  • Retrieval system 200 includes elongate outer tubular member 210 including distal cup 230 and a retrieval assembly 40.
  • Retrieval assembly 40 has been extended through a distal opening 203 of distal cup 230.
  • distal cup 230 may include a substantially rigid material, e.g., relatively more rigid than elongate outer tubular member 210 and/or retrieval assembly 40.
  • Retrieval assembly 40 includes an elongate member 43 extending within a catheter 4 land defining a distal snare 42. Snare 42 may be slidably engaged within catheter 41 to expand (e.g., open) and contract (e.g., close) a loop thereof.
  • retrieval assembly 40A may include a loop snare 42A. Loop snare 42A includes a single metal wire loop.
  • retrieval assembly 40B may include a triple loop snare 42B. Triple loop snare 42B may include three metal wire loops.
  • snare 42 may include other suitable types of snare, including, but not limited to, a net or a hook. Regardless of the type of snare, snare 42 may include any suitable braided or non-braided metal, such as, for example, stainless steel, nickel titanium alloy, radiopaque elements such as gold or platinum iridium coil wrapping wires and/or bands, or the like.
  • FIG. 4A illustrates snare 42 is in an expanded configuration.
  • a clinician may maneuver the snare 42 into position around a neck N of proximal retrieval feature 310.
  • a clinician may attempt to deflect catheter 41 in the direction of arrow R by rotating catheter 41 relative to elongate outer tubular member 210.
  • a proximal end of retrieval assembly 40 may include a torque member to rotate catheter 41.
  • the clinician may move catheter in the direction of arrow L by extending catheter 41 distally relative to elongate outer tubular member 210.
  • maneuvering retrieval assembly 40 in only directions R and L may be difficult, particularly in view of imaging the movement of retrieval system 200 via fluoroscopy, and time consuming.
  • the clinician may have difficulty orienting the snare in three-dimensional scape to revise IMD 300. Additionally, or alternatively, the clinician may inadvertently engage snare 42 around device housing 380, rather than around neck N of proximal retrieval feature 310. Additionally, or alternatively, once the clinician has successfully engaged snare 42 around proximal retrieval feature neck N, IMD 300 may be misaligned with distal opening 203 of receptacle 230, such that extracting device 300 from the implant site and drawing device 300 into receptacle 230 may be difficult.
  • FIG. 5A-5D are conceptual diagrams illustrating an example IMD retrieval system 500.
  • IMD retrieval system 500 includes elongate outer tubular member 502 and retrieval assembly 504.
  • Outer tubular member 502 may include a longitudinally extending lumen terminating in distal tip 508 of a distal cup 506.
  • Distal cup 506 may be configured to receive an IMD, such as IMD 300.
  • distal cup 506 may include one or more walls defining a cavity having an inner diameter sized to contain an IMD therein.
  • distal cup 506 may be substantially straight, e.g., the walls of distal cup 506 may be substantially parallel to a longitudinal axis defined by the outer tubular member 502.
  • distal cup 506 may include a substantially rigid material, e.g., relatively more rigid than elongate outer tubular member 502 and/or retrieval assembly 504.
  • distal cup 506 may be sufficiently rigid to provide a selective resistive force against retrieval assembly 504 (e.g., distal curve 522 of fixed-curve catheter 516) to urge retrieval assembly 504 into a substantially straight configuration when retracted into distal cup 506.
  • outer tubular member 502 may include a proximal handle 510 configured to enable a clinician to manipulate outer tubular member 502. For example, a clinician may use handle 510 to introduce outer tubular member 502 into the vasculature of a patient, rotate outer tubular member 502, and/or introduce therapeutic agents via coupling 512.
  • outer tubular member 502 may include a pull wire configured to allow a clinician to cause a deflection (e.g., a deflectable-curve) of a distal end of outer tubular member 502. For example, the pull wire may be actuated by sliding control button 511.
  • a deflection e.g., a deflectable-curve
  • Retrieval assembly 504 may include a retrieval member 514 and a fixed-curve catheter 516.
  • Retrieval member 514 may include an elongate member terminating in at least one snare 518.
  • Retrieval member 514 may be controllable, e.g., by a control member 521 or other control member operable by a clinician, to slid in the proximal-distal direction or rotate.
  • At least one snare 518 may be moveable (e.g., controllable), by a torque member 520 or other control member operable by a clinician, between an expanded configuration and a contracted configuration.
  • Fixed-curve catheter 516 may include a resilient material defining elongate member having a lumen and terminating in distal tip 524.
  • Fixed-curve catheter 516 may include a distal curve 522 adjacent and proximal to distal tip 524.
  • distal curve 522 may include a deflection of a distal portion of fixed-curve catheter 516 relative to the longitudinal axis of retrieval assembly 504, e.g., a portion of fixed-curve catheter 516 proximal to distal curve 522.
  • distal curve 522 may include any suitable deflection angle 523, such as for example a deflection between about 1-degree and about 180-degrees, such as between about 45-degree and 135-degrees.
  • a local environment surrounding retrieval assembly 504 may affect deflection angle 523.
  • deflection angle 523 may be relatively greater in an ambient environment and relatively less inside the environment of a patient's body due to, for example, a temperature of the patient's body.
  • a proximal end 526 of fixed-curve catheter 516 may define a control member configured to manipulate fixed-curve catheter 516, such as, for example, to slid in the proximal-distal direction or rotate.
  • FIGS. 6A and 6B are conceptual and schematic diagrams illustrating cross-sectional side and axial views of an example IMD retrieval system 600.
  • IMD retrieval system 600 may be the same as or substantially similar to IMD retrieval system 500 discussed above in reference to FIGS. 5A-5D .
  • IMD retrieval system 600 includes an elongate outer tubular member 602 and a retrieval assembly 604.
  • Outer tubular member 602 may define a longitudinally extending lumen 603 terminating in a distal cup 606 having a distal opening 608.
  • Outer tubular member 602 may include a proximal handle 610 configured to enable a clinician to manipulate outer tubular member 602, e.g., to manipulate a pull wire of .
  • outer tubular member 602 may include any suitable construction, such as, for example, a coiled or braided metal coated on an external surface and internal surface with one or more polymers.
  • Retrieval assembly 604 may include a retrieval member 614 and a fixed-curve catheter 616.
  • Retrieval member 614 may include a retrieval member catheter 632 defining a lumen 631 within which an elongate retrieval member 630 extends in sliding engagement.
  • Retrieval member 614 may include any suitable construction, such as, for example, a polymeric tube.
  • Elongate retrieval member 630 terminates in at least one snare 618.
  • Elongate retrieval member 630 may include a braided, non-braided, or partially braided wire including any suitable material, such as, for example, a metal, nickel titanium alloy, stainless steel, or the like.
  • At least one snare 618 may be moveable (e.g., controllable), via a torque member 620 or other control member operable by a clinician.
  • drawing elongate retrieval member 630 in a proximal direction into retrieval member catheter 632 may cause at least one snare 618 to convert from an expanded configuration to a contracted configuration.
  • retrieval member 614 may extend in sliding engagement within the lumen of fixed-curve catheter 616.
  • fixed-curve catheter 616 may include lumen 617 configured to receive retrieval member 614 such that retrieval member 614 extends through lumen 617.
  • Fixed-curve catheter 616 is straight for the purposes of illustrations, however, in some examples, fixed-curve catheter may include a deflection such that distal tip 624 and/or a portion of distal curve 622 may contact an interior wall of distal cup 606.
  • retrieval member 614 may be sufficiently flexible to conform to the shape of fixed-curve catheter 616, e.g., distal curve 622. In this way, retrieval member 614 and fixed-curve catheter 616 may be configured to define coaxial retrieval assembly 604.
  • fixed-curve catheter 616 may include a multilayer construction.
  • fixed-curve catheter 616 may include core layer 636, an interior layer 634, and an exterior layer 638.
  • Core layer 636 may include a coiled metal wire or braided metal wire.
  • core layer 636 may include a single filar or bifilar metal wire formed on a mandrel.
  • Interior layer 634 may include any suitable polymer, such as, for example, polytetrafluoroethylene, high-density polyethylene, poly ether block amide, or another polymer configured to enable retrieval member 614 to readily slide in lumen 617.
  • Exterior layer 638 may include any suitable polymer, such as, for example, polyethylene, polypropylene, polyether block amide or another polymer configured to enable fixed-curve catheter 616 to readily slide in lumen 603.
  • the polymer of exterior layer 638 may be selected to be flowable between filars of core layer 636 during formation of exterior layer to enable the catheter to retain the curved shape, e.g., during heating.
  • distal tip 624 of fixed-curve catheter 616 may include only core layer 636.
  • interior layer 634 and exterior layer 638 may not extend distally as far as core layer 636.
  • distal tip 624 may include separate metal coil wound around a distal end of fixed-curve catheter 616.
  • distal tip 624 may include separate over-molded polymer, such as, for example, polyether block amide with radiopaque additives, such as bismuth subcarbonate, barium sulfate, or tungsten.
  • the separate metal coil or over-molded polymer may be more robust than a distal tip including only core layer 636.
  • the distal end of fixed-curve catheter 616 may be configured to engage snare 618 and/or a portion of an IMD 300 when retrieval member 614 is engaged with an IMD 300 and drawn in a proximal direction into lumen 617 of fixed-curve catheter 616.
  • fixed-curve catheter 616 may include regions of increased stiffness compared to other regions of fixed-curve catheter 616.
  • a region of core layer 636 defining distal curve 622 of fixed-curve catheter 616 may include a region of increased stiffness compared to a region of fixed-curve catheter 616 proximal to distal curve 622.
  • Stiffness of core layer 636 may be controlled by, for example, controlling a pitch of the filars of core layer 636.
  • stiffness of fixed-curve catheter 616 may be controlled by selection or treatment of interior layer 634 and/or exterior layer 638.
  • a region of increased stiffness may include a thicker exterior layer 638 or the region may be heat treated to stiffen the polymer of exterior layer 638.
  • interior layer 634 and/or exterior layer 683 may include a plurality of segments, each respective segment including one or more polymers having a selected durometer to provide a desired stiffness of the respective segment. Controlling the stiffness of fixed-curve catheter 616 may improve the ability of distal curve 622 to take on a desired curved configuration when extended from the distal cup 606 and/or increase the flexibility of fixed-curve catheter 616 proximal to distal curve 622 to better enable IMD retrieval system 600 to be introduced into the vasculature of the patient.
  • fixed-curve catheter 616 may extend in sliding engagement within lumen 603 of outer tubular member 602.
  • outer tubular member 602 may include lumen 603 configured to receive fixed-curve catheter 616 such that retrieval assembly 604 extends through lumen 603. In this way, retrieval assembly 604 and outer tubular member 602 may be configured to define coaxial retrieval system 600.
  • the distal cup and the fixed-curve catheter are configured to adjustably control the degree of the distal curve, e.g., the angle between the longitudinal axis of the distal cup and the snare.
  • FIG. 7A-7E are conceptual diagrams illustrating adjustable control of the degree of curve of the distal end of an example IMD retrieval system 700.
  • IMD retrieval system 700 may be the same as or substantially similar to IMD retrieval systems 400, 500, and/or 600 discussed above in reference FIGS. 4A-6B .
  • IMD retrieval system 700 includes outer tubular member 702 and retrieval assembly 704 that includes retrieval member 714 and fixed-curve catheter 716.
  • fixed-curve catheter 716 may extend in sliding engagement within a lumen of elongate outer tubular member 702. By including distal curve 722 in sliding engagement with the lumen of outer tubular member 702, the degree of distal curve 722 of fixed-curve catheter 716 is controllable.
  • distal curve 722 may take a substantially straight configuration when retracted into distal cup 706 of outer tubular member 702.
  • a longitudinal axis of retrieval member 714 may be substantially the same as the longitudinal axis of distal cup 706.
  • substantially the same may include an angle of the longitudinal axis of retrieval member 714 relative to longitudinal axis of distal cup 706 of less than 10-degrees, such as less than 5-degrees or less than 1-degree.
  • distal cup 706 is sufficiently rigid, and fixed-curve catheter is sufficiently flexible, such that distal cup 706 urges fixed-curve catheter 716 into a substantially straight configuration, e.g., straight or nearly straight relative to the longitudinal axis of distal cup 706.
  • distal curve 722 may take a partially curved configuration when partially extended from distal opening 708 of distal cup 706.
  • a longitudinal axis of retrieval member 714 may bend at an angle relative to the longitudinal axis of distal cup 706.
  • the angle of the longitudinal axis of retrieval member 714 relative to longitudinal axis of distal cup 706 may be between about 1-degree and about 45-degrees, such as between about 10-degrees and about 40-degrees.
  • the curve of fixed-curve catheter 716 may be more pronounced.
  • the angle of the longitudinal axis of retrieval member 714 relative to longitudinal axis of distal cup 706 may be between about 30-degree and about 70-degrees, such as between about 30-degrees and about 50-degrees.
  • the adjustable curve of fixed-curve catheter 716 provides enhanced steering of the snare 718. For example, by enabling a clinician to control a degree of curvature of the fixed-curve catheter 716, the clinician may more accurately and efficiently guide snare 718 to an IMD, such as IMD 300.
  • outer tubular member 702 may include a deflectable-curve portion 703.
  • deflectable-curve portion 703 may be fixed in the same manner as discussed above with respect to fixed-curve catheter 716 (e.g., fixed-curve catheter 616).
  • fixed-curve catheter 716 may enable secondary curves of IMD retrieval system 700.
  • the secondary curves may be manipulated by a clinician, e.g., by controlling the degree of curvature of the fixed-curve catheter, the radial orientation of the distal curve of the fixed-curve catheter relative to the curve of the elongate outer tubular member, or both, to improve control of the snare in three-dimensional space.
  • fixed-curve catheter 716 may be axially oriented relative to outer tubular member 702, such that distal curve 722 and deflectable-curve portion 703 generally curve in the same direction. In this way, the total deflection of snare 718 may be greater than if a retrieval device with only one of distal curve 722 or deflectable-curve portion 703.
  • fixed-curve catheter 716 may be axially oriented relative to outer tubular member 702, such that distal curve 722 and deflectable-curve portion 703 generally curve in different directions.
  • a clinician may have greater control of the position and orientation of snare 718 in a three-dimensional space. Greater control of the position and orientation of snare 718 in a three-dimensional space may reduce die time necessary for die clinician to properly receive the IMD in snare 718.
  • FIG. 8A-8H are conceptual diagrams illustrating engagement of snare 818 of IMD retrieval system 800 with proximal retrieval feature 852 on IMD 850.
  • IMD retrieval system 800 may be the same as or substantially similar to IMD retrieval systems 400, 500, 600, and/or 700 discussed above in reference FIGS. 4A-7E .
  • IMD retrieval system 800 includes outer tubular member 802 having distal cup 806 with distal opening 808 and retrieval assembly 804 that includes retrieval member 814 having snare 818 and fixed-curve catheter 816 having distal curve 822.
  • fixed-curve catheter 816 may extend in sliding engagement within a lumen of elongate outer tubular member 802 and axially rotate around a longitudinal axis of retrieval assembly 804.
  • snare 818 may receive IMD 850 by encircling housing 854 of IMD 850.
  • the clinician may control the degree and/or orientation of distal curve 822 of fixed-curve catheter 816 to apply a side load (e.g., in the direction indicated by arrow 860) to housing 854.
  • the side load may slightly tip IMD 850.
  • a side load to the IMD housing may be urge at least a portion of snare 818 to ride along housing 854 as snare 818 is slid proximally over housing 854, the side load helps snare 818 catch groove 856 of proximal retrieval feature 852 on IMD 850, as illustrated in FIG. 8C .
  • snare 818 may be controlled by the clinician from an expanded configuration to a partially contracted configuration before snare 818 is slid proximally over housing 854.
  • the partial contracted configuration, together with application of the side load may prevent snare 818 from slipping over proximal retrieval feature 852 as snare 818 is slid proximally over housing 854.
  • snare 818 may be controlled by the clinician from an expanded configuration to a contracted configuration (e.g., fully contracted configuration) to engage IMD 850, as illustrated in FIG. 8D .
  • the orientation of IMD 850 relative to distal cup 806 may make it difficult to seat distal cup 806 over IMD 850 prior to retrieval.
  • distal opening 808 of the distal cup may catch in groove 856 of proximal retrieval feature 852.
  • axial rotation of outer tubular member 802 relative to fixed-curve catheter 816 engaged with IMD 850 e.g., as indicated by arrow 862, may facilitate reorienting distal cup 806 relative to IMD 850.
  • axial rotation of the fixed-curve catheter may enable distal cup 860 to change orientation relative to IMD 850.
  • changing the orientation of distal cup 806 relative to IMD 850 may guide distal cup 806 to an orientation that allows IMD 850 to seat (e.g., be retrieved) in distal cup 806.
  • the system may reduce the time to properly engage the IMD for retrieval.
  • FIG. 9A-9F are conceptual diagrams illustrating retrieval of an implantable medical device by urging distal end 924 of fixed-curve catheter 916 against proximal retrieval feature 952 of IMD 950 to facilitate seating of IMD 950 in distal cup 906 of IMD retrieval system 900.
  • IMD retrieval system 900 may be the same as or substantially similar to IMD retrieval systems 400, 500, 600, 700, and/or 800 discussed above in reference FIGS. 4A-3H.
  • IMD retrieval system 900 includes outer tubular member 902 having distal cup 906 with distal opening 908 and retrieval assembly 904 that includes retrieval member 914 having snare 918 and fixed-curve catheter 916 having distal curve (not shown).
  • retrieval member 914 may extend in sliding engagement within a lumen of fixed-curve catheter 916. The sliding engagement may enable a clinician to advance distal end 924 of fixed-curve catheter to IMD 950 to facilitate seating of distal cup 906 onto IMD 950.
  • distal end 924 of fixed-curve catheter 916 may be slid up to proximal retrieval feature 952, as illustrated in FIG. 9B .
  • distal end 924 may include a coil tip that is sized to divert distal cup 906 away from groove 956 of proximal retrieval feature 952.
  • distal cup 906 may be advanced over IMD 950 without catching groove 956. Then, as illustrated in FIGS. 9E and 9F , distal cup 906 may be advanced over IMD 950 to fully seat IMD 950 within distal cup 906.
  • FIG. 10A and 10B are conceptual diagrams illustrating retrieval of IMD 1050 by using fixed-curved catheter 1016 of IMD retrieval system 1000 to cinch snare 1018 into a contracted configuration.
  • IMD retrieval system 1000 may be the same as or substantially similar to IMD retrieval systems 400, 500, 600, 700, 800, and/or 900 discussed above in reference FIGS. 4A-9F .
  • IMD retrieval system 1000 includes outer tubular member (not shown) and retrieval assembly 1004 that includes retrieval member 1014 having snare 1018 and fixed-curve catheter 1016 having distal curve (not shown).
  • retrieval member 1014 may extend in sliding engagement within a lumen of fixed-curve catheter 1016.
  • Tire sliding engagement may enable a clinician to advance distal end 1024 of fixed-curve catheter 1016 to snare 1018 to facilitate controlling snare 1018 from an expanded configuration to a contracted configuration.
  • snare 1018 may include an expanded configuration.
  • the expanded configuration includes a loop sized to receive an IMD, e.g., to fit over the housing of the IMD.
  • distal end 1024 of fixed-curve catheter 1016 may be advanced in the distal direction to snare 1018.
  • retrieval member 1014 may be drawn in die proximal direction to effectively advance distal end 1024 to snare 1018.
  • Advancing distal end 1024 toward snare 1018 may draw snare 1018 into the lumen of fixed-curve catheter 1016, For example, when an IMD is receive in snare 1018, advancing distal end 1024 over snare 1018 may control snare 1018 to take a contracted configuration to engage the IMD, such as the proximal retrieval feature of the IMD. In this way, advancing distal end 1024 over snare 1018 may lock snare 1018 in the contracted configuration, thereby securely engaging an IMD, which may enable a clinician to manipulate the orientation of the outer tubular member and/or fixed-curve catheter relative to the IMD without snare 1018 disengaging from the IMD.
  • FIG. 11 is a flow diagram illustrating a non-claimed example method of manufacturing a fixed-curve catheter of an IMD retrieval system.
  • the technique illustrated in FIG. 11 is described in reference to IMD retrieval system 600 illustrated in reference to FIGS. 6A and 6B , the technique may be used to manufacture other IMD retrieval systems, such as IMD retrieval systems 400, 500, 700, 800, 900, and/or 1000. Additionally, IMD retrieval systems 400, 500, 700, 800, 900, and/or 1000 may be manufactured using other techniques,
  • interior layer 634 includes depositing a polymer to form interior layer 634 (1102). Any suitable deposition or coating method may be used to deposit interior layer 634. As discussed above, interior layer 634 may include any suitable polymer, such as, for example, polytetrafluoroethylene.
  • the technique illustrated in FIG. 11 includes forming core layer 636 (1104).
  • forming core layer 636 may include winding one or more metal wires onto a mandrel.
  • forming core layer 636 may include braiding two or more metal wires onto a mandrel.
  • forming core layer 636 may include forming core layer 636 directly over interior layer 634.
  • the technique illustrated in FIG. 11 includes depositing a polymer onto an exterior surface of core layer 636 to form exterior layer 638 (1106). Any suitable deposition or coating method may be used to deposit exterior layer 638. As discussed above, exterior layer 638 may include any suitable polymer, such as, for example, polyether block amide. Exterior layer 638 may at least partially flow into spaces between filars of core layer 636.
  • the technique may include forming distal tip 624, e.g., by winding a metal coil or over-molding a polymer onto fixed-curve catheter 616.
  • the technique may include forming an over-molded proximal hub, such as, for example, onto proximal end 626.
  • shaping core layer 636 may include heating fixed-curve catheter 616, bending fixed-curve catheter 616, and cooling fixed-curve catheter 616 to set the distal curve 622.
  • forming core layer 636 and shaping core layer 636 may be performed in a single step.
  • forming core layer 636 may include winding (or braiding) metal wires onto a mandrel including a curve that substantially corresponds to the described curvature of distal curve 622.
  • the technique may include forming outer tubular member 602.
  • die technique may include forming retrieval member 614.
  • the technique may include inserting retrieval member 614 into lumen 617 of fixed-curve catheter 616 to form retrieval assembly 604.
  • the technique may include inserting retrieval assembly 604into lumen 603 of outer tubular member 602 to form IMD retrieval system 600,
  • FIG. 12 is a flow diagram illustrating a non-claimed example method of using an implantable medical device retrieval system.
  • the technique illustrated in FIG. 12 is described in reference to IMD retrieval system 500 illustrated in reference to FIGS. 5A-5D , the technique may be used with other IM D retrieval systems, such as IMD retrieval systems 400, 600, 700, 800, 900, and/or 1000, Additionally, IMD retrieval systems 400, 600, 700, 800, 900, and/or 1000 may be used with other techniques.
  • the technique illustrated in FIG. 12 includes introducing the IMD retrieval system 500 into the vasculature of a patient (1202).
  • introducing the IMD retrieval system 500 may include creating an incision in the femoral vein of the patient.
  • introducing the IMD retrieval system 500 may include navigating, with the assistance of fluoroscopy, the IMD retrieval system 500 to a target chamber of the heart of the patient.
  • introducing the IMD retrieval system 500 may include aligning distal tip 524 of fixed-curve catheter 516 adjacent and/or touching the IMD.
  • the position of the distal tip 52.4 of fixed-curve catheter 516 may be confirmed using two orthogonal views via fluoroscopy.
  • the technique illustrated in FIG. 12 includes controlling retrieval assembly 504 to receive the IMD in snare 518 (1204).
  • a clinician may manipulate handle 510 and/or torque member 5 20 coupled to fixed-curve member 516 and/or outer tubular member 502 to position and orient snare 518 to loop snare 518 over a housing of the IMD.
  • the clinical may manipulate handle 510 to apply tension to snare 518 in a direction transverse to a longitudinal axis of the IMD.
  • the clinician may control retrieval assembly 504 to move snare 518 toward a proximal end of the IMD, e.g., toward the proximal retrieval feature, until snare 518 engages the catch groove of the proximal retrieval feature.
  • the technique illustrated in FIG. 12 includes controlling retrieval assembly 504 to engage the IMD (1206).
  • a clinician may manipulate the retrieval member 514 to control snare 518 from an expanded configuration to a contracted configuration.
  • a clinician may manipulate fixed-curve catheter to control snare 5 18 from an expanded configuration to a contracted configuration and/or to effectively lock snare 518 in the contracted configuration.
  • the technique illustrated in FIG. 12 includes controlling retrieval assembly 504 to retrieve the IMD (1208).
  • a clinician may manipulate fixed-curve member 316 and/or outer tubular member 502 to position and orient distal cup 506 to seat the IMD inside the distal cup
  • retrieving the IMD may include application of a proximal force sufficient to dislodge the IMD from the tissue of the patient.
  • retrieving the IMD may include withdrawing the IMD retrieval system from the vasculature of the patient.

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Claims (11)

  1. Rückholsystem für eine implantierbare medizinische Vorrichtung (IMD), umfassend:
    ein längliches äußeres röhrenförmiges Element (502), einschließlich eines sich in Längsrichtung erstreckenden Lumens, das in einem distalen Becher (506) endet, wobei der distale Becher konfiguriert ist, um die IMD aufzunehmen; und
    eine Rückholanordnung (504), umfassend:
    ein Rückholelement (514), umfassend ein längliches Element, das in mindestens einer Schlinge (518) endet, wobei die mindestens eine Schlinge zwischen einer erweiterten Konfiguration und einer zusammengezogenen Konfiguration bewegbar ist; und
    einen Katheter (516) mit fester Krümmung, umfassend ein elastisches Material, das eine distale Krümmung ausbildet, und der ein Lumen, in den sich das Rückholelement in Gleiteingriff erstreckt, definiert, wobei sich der Katheter mit fester Krümmung in Gleiteingriff innerhalb des Lumens des länglichen äußeren röhrenförmigen Elements erstreckt,
    wobei der Katheter mit fester Krümmung relativ zu dem länglichen äußeren röhrenförmigen Element drehbar ist.
  2. System nach Anspruch 1, wobei der Katheter mit fester Krümmung zwischen einer im Wesentlichen geraden Konfiguration, wenn er in den distalen Becher des länglichen äußeren röhrenförmigen Elements zurückgezogen wird, und einer mindestens teilweise gekrümmten Konfiguration, wenn er von dem distalen Ende des distalen Bechers mindestens teilweise gestreckt wird, steuerbar ist.
  3. System nach Anspruch 1 oder 2, wobei der Katheter (616) mit fester Krümmung umfasst:
    eine längliche Kernschicht (636), umfassend einen gewickelten oder geflochtenen Metalldraht, wobei die Kernschicht eine Außenoberfläche und eine Innenoberfläche definiert, die das Lumen des Katheters mit fester Krümmung definiert;
    eine innere Schicht (634), die an der Innenoberfläche der Kernschicht eingerichtet ist; und
    eine äußere Schicht (638), die an der Außenoberfläche der Kernschicht eingerichtet ist.
  4. System nach Anspruch 3, wobei der Metalldraht der Kernschicht Edelstahl umfasst.
  5. System nach Anspruch 3 oder 4, wobei die innere Schicht Polytetrafluorethylen umfasst.
  6. System nach einem der Ansprüche 3 bis 5, wobei die äußere Schicht Polyetherblockamid umfasst.
  7. System nach einem der Ansprüche 1 bis 6, wobei der Katheter mit fester Krümmung ferner relativ zu dem Rückholelement drehbar ist.
  8. System nach einem der Ansprüche 1 bis 7, wobei das längliche äußere röhrenförmige Element eine auslenkbare Krümmung proximal zu dem distalen Becher einschließt.
  9. System nach einem der Ansprüche 1 bis 8, wobei das Rückholelement eine Schlaufenschlinge (518) umfasst, die mindestens eine Drahtschlaufe aufweist, die konfiguriert ist, um in einer zusammengezogenen Konfiguration der mindestens einen Drahtschlaufe die IMD in Eingriff zu nehmen.
  10. System nach einem der Ansprüche 1 bis 9, wobei die mindestens eine Schlinge konfiguriert ist, um ein proximales Rückholmerkmal (310), das an einem proximalen Ende (381) eines Gehäuses (380) der IMD eingerichtet ist, in Eingriff zu nehmen.
  11. System nach einem der Ansprüche 1 bis 10, wobei die erweiterte Konfiguration der mindestens einen Schlinge konfiguriert ist, um sich über ein Gehäuse (380) der IMD zu bewegen, und wobei die zusammengezogene Konfiguration der mindestens einen Schlinge konfiguriert ist, um die mindestens eine Schlinge mit einem proximalen Rückholmerkmal (310), das an einem proximalen Ende (381) eines Gehäuses (380) der IMD eingerichtet ist, mechanisch zu koppeln.
EP19795390.4A 2018-10-10 2019-10-09 Rückholwerkzeug für medizinische vorrichtungen mit einstellbarer krümmung Active EP3863534B1 (de)

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US201862743939P 2018-10-10 2018-10-10
US16/596,252 US20200113602A1 (en) 2018-10-10 2019-10-08 Medical device retrieval tool with adjustable curve
PCT/US2019/055363 WO2020076926A1 (en) 2018-10-10 2019-10-09 Medical device retrieval tool with adjustable curve

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EP3863534B1 true EP3863534B1 (de) 2024-03-13

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US20220168036A1 (en) * 2020-11-30 2022-06-02 Evalve, Inc. Systems, apparatuses, and methods for removing a medical implant from cardiac tissue

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US6635047B2 (en) * 2001-08-06 2003-10-21 Scimed Life Systems, Inc. Integrated polymer and braid for intravascular catheters
US10112045B2 (en) 2010-12-29 2018-10-30 Medtronic, Inc. Implantable medical device fixation
EP2811920A1 (de) * 2012-02-09 2014-12-17 Boston Scientific Scimed, Inc. Lenkbare medizinische vorrichtungen zur gewebebehandlung und zugehörige
US9526522B2 (en) 2013-09-27 2016-12-27 Medtronic, Inc. Interventional medical systems, tools, and assemblies
US20170043158A1 (en) * 2015-08-12 2017-02-16 Medtronic, Inc. Interventional medical systems and catheters
US10758729B2 (en) * 2015-10-01 2020-09-01 Medtronic, Inc. Interventional medical systems, catheters, and methods
US10737092B2 (en) * 2017-03-30 2020-08-11 Cardiac Pacemakers, Inc. Delivery devices and methods for leadless cardiac devices

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